Securing Market Access: Reimbursement, Payer Relationships and Healthcare Reform

Securing Market Access: Reimbursement, Payer Relationships and Healthcare Reform published by Cutting Edge Information in July, 2009. This report consists of 90 Pages and the price starts from US $ 7695.

Introduction

Abstract

Strengthen payer relationships through communication:

Of all factors contributing to product success, payer access could be the most critical. Without the best reimbursement status for a drug, the investments your company made during drug development may end up as a lost cause. Securing Market Access: Reimbursement, Payer Relationships and Healthcare Reform examines the processes, strategies and best practices that industry leaders have implemented to build strong relationships and gain payer access.

This report is a tool for companies to adjust their strategies to meet growing payer demands and facilitate the reimbursement process:

Improve payer communication and formulary submission success.

Metrics on payer targeting, communication methods and timing guide the strategic recommendations leading to healthier and more lucrative relationships for pharmaceutical companies with payers.

Increase the efficiency of your managed market department:

Analyze benchmarking data from surveyed companies on organizational structure, headcount distribution for various functions within the managed markets group, account distribution and resource allocation.

Understand the impact of potential healthcare reform on managed markets teams

Although there are no clear-cut solutions to healthcare reform, this report provides recommendations for drug companies to prepare for both minor and major changes to the healthcare system. Interviewed pharmaceutical executives discuss their strategic responses to potential changes that could be on the managed markets horizon. Cutting Edge Information' s analysts designed the practices contained within to help managed markets teams develop strategies to respond effectively to various scenarios that could emerge.

Table of Contents

Metrics Overview

Securing Market Access' three chapters include structure, budget, staffing and key performance metrics data collected from 20 top pharmaceutical and biotechnology companies.

Strengthening Payer Relationships through Communication

Percentage of all companies specific targeting managed care institutions, by type of account:

• Commercial managed care (MCOs)
• Medicare/Medicaid (federal and state)
• Long-term care
• Industry/trade
• Federal markets (DoD, VHA)

Percentage of companies targeting managed care groups, by portfolio type:

• Primary care (companies that develop and/or market a majority of primary care products)
• Specialty (develop and/or market a majority of specialty products)
• Product-Balanced (manage a relatively even-split between primary-care and specialty products)

• Ranking of importance for managed care institutions
• Ranking of importance for managed care institutions, by portfolio type (primary care, specialty, and product-balanced)
• Development phase during which companies initially contact payers
• Number of contacts with payers during each phase of development
• Payer interfaced per phase by portfolio type (primary care, specialty, and product-balanced)
• Percentage of companies' preferred methods of communication with payers, by phase: email, telephone, face-to-face
• Year after drug approval that communication with payers stops

Managed Markets Structure, Staffing and Budgets

• Percentage of companies with formal managed markets departments
• Departments in which managed markets groups typically reside
• Average staff size of a managed markets department (in FTEs)
• Average staffing allocation of a managed markets department' s personnel
• Average managed markets FTE allocation by portfolio type (primary care, specialty, and product-balanced)
• Average FTEs per product ratios by portfolio type (primary care, specialty, and product-balanced)
• FTEs and FTE-to-product ratios by portfolio type (primary care, specialty, and product-balanced)
• Account manager FTEs by product focus and type of account
• Account manager per product by company and type of manager (regional account managers or national account managers)
• Percentage of companies that organize account managers by geography, by portfolio type (primary care, specialty, and product-balanced)
• Average budget for a managed markets department
• Average budget allocation for a managed markets department
• Average budget per product ratios by portfolio type (primary care, specialty, and product-balanced)
• Budgets by portfolio type: primary care-product-focused (as well as specialty-focused and balanced) companies - also per product
• Managed markets marketing budget allocation by portfolio type (primary care, specialty, and product-balanced)
• Managed markets sales manager budget allocation by portfolio type (primary care, specialty, and product-balanced)
• Managed markets account manager budget allocation by portfolio type (primary care, specialty, and product-balanced)
• Managed markets administrative budget allocation by portfolio type (primary care, specialty, and product-balanced)

Healthcare Reform and its Impact on Managed Markets Teams

• Cost ranges for comparative effectiveness research
• NICE' s probability of Rejection vs. Cost per QALY

Additional Data

• Percentage breakdown of all healthcare spending by payers
• Average costs for pharmacoeconomic research

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